A painkiller and a walk 'help' back pain

Steroid drugs and visits to the physiotherapist do nothing to
speed up recovery from back pain, an Australian study has
found.

Tests on 240 back pain sufferers in Sydney found that simple
over-the-counter painkillers and advice to stay active are the best
possible treatments to aid recovery.

Patients prescribed additional anti-inflammatory drugs or spinal
manipulative therapy, both recommended to speed up recovery, did
not recover any faster, according to the study, published in The
Lancet medical journal.

The researchers, from the Back Pain Research Centre at the
University of Sydney, say GPs should no longer expose their
patients to the "increased risks and costs" of these therapies on
the basis of these results.

More than 20 per cent of Australians seek help for back pain
each year.

There are myriad treatments available, so researchers set out to
test the benefits of different combinations.

They enlisted 240 people suffering short-term acute low back
pain and gave them all paracetamol and advice to stay active, the
recommended first line of treatment.

Patients also were randomly assigned various combinations of the
non-steroidal anti-inflammatory (NSAID) diclofenac and manipulative
therapy performed by a physiotherapist, including dummy versions of
each therapy.

"Neither diclofenac nor spinal manipulative therapy gave
clinically useful effects on the primary outcome of time to
recovery," wrote lead author Mark Hancock.

He said these results were important because both treatments had
potential risks and additional costs for patients.

NSAIDs, in particular, have been under a cloud after big-selling
drug Vioxx was linked to increased risk of heart attack and
stroke.

"If patients have high rates of recovery with baseline care and
no clinically worthwhile benefit from the addition of diclofenac or
spinal manipulative therapy, then GPs can manage patients
confidently without exposing them to increased risks and costs
associated with NSAIDs or spinal manipulative therapy," the authors
wrote.

Commenting on the findings, Dutch expert Dr Bart Koes, from the
Erasmus University Medical Centre in Rotterdam, said it was now
clear that paracetamol and advice were "sufficient for most
patients".

Dr Dennis Richards, president of the Chiropractors' Association
of Australia, said the results should not turn people off
manipulative therapy.

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